PORT ANGELES — As Peninsula Behavioral Health stabilizes its staffing and grows its services, the organization is keeping a careful eye on proposed Medicaid cuts that could deal devastating blows.
State-level cuts to specific programs also are possible, if the budget under review by Gov. Bob Ferguson is signed into law.
Peninsula Behavioral Health (PBH) provides a broad scope of services to Clallam County, including crisis response and stabilization, homeless outreach services, jail transition support, permanent supportive housing and transitional housing, life skills training, employment support, psychiatric evaluation services, substance use disorder and more.
“We are really the safety net provider for behavioral health,” PBH CEO Wendy Sisk said, noting that about 85 percent of PBH’s funding comes from Medicaid and about one-third of county residents rely on the insurance.
With the U.S. House of Representatives proposing a budget that would include substantial cuts to Medicaid, Sisk is worried about how it might impact PBH’s services.
“Anything related to Medicaid might be eliminated,” Sisk told the Clallam County commissioners during their Monday work session. “I think there’s a lot of risk of services being unfunded or underfunded depending on how the federal government approaches cutting things.”
If large federal cuts were to occur, Sisk said she imagines every Medicaid provider would have to look at both its programmatic offerings and staffing levels.
“We don’t have a lot of excess revenue over expense,” Sisk said.
Currently, PBH is using the little wiggle room it has to absorb a 1 percent Medicaid cut that occurred at the state level.
In addition to worries about standard Medicaid, traditionally for low-income seniors and those with disabilities, Sisk said she is concerned about the impact that cuts could have on Medicaid expansion. Also known as Obamacare, this program offers Medicaid to low-income individuals solely based on their income levels. Many PBH patients are covered under Medicaid expansion.
In 2023, the federal government paid almost 70 percent of standard Medicaid costs across the 50 states — averaging out to about $1 billion for Washington state per year, Sisk said. With Medicaid expansion, however, Sisk said the federal government pays about 90 percent of the state’s costs.
If that funding is eliminated or cut, Sisk said she’s not sure the state would be able to backfill those costs.
“It’s certainly something that we’re monitoring,” she said.
Currently, PBH doesn’t turn anyone away based on their ability to pay, both because it is an approved National Health Service Corps Loan Repayment site and is a Certified Community Behavioral Health Clinic.
However, Sisk noted the ability to continue providing service regardless of ability to pay is a “finite resource.”
“Our mission is to provide care to those in our community who need it,” Sisk said. “[But] we still have to be financially sustainable.”
And, although Medicaid cuts would have a devastating impact on most of PBH’s offerings, the two programs PBH is expanding seem to largely remain safe.
The first, an expansion of competency evaluations and care for individuals with mental illnesses held in jail, involves court-ordered state funding that was achieved through the Trueblood class action lawsuit.
The other expanding program is crisis intervention services provided by an advanced mobile crisis outreach team. Because a portion of the funding for that program does come from Medicaid, it could see some impact.
While about 85 percent of PBH’s funding comes from Medicaid, Sisk said most of the other 15 percent is funded by state dollars with very little coming through private insurance.
Although most of the state funding is secure, PBH’s recovery navigator program (Recovery, Engagement, Advocacy and Linkage, or R.E.A.L.) will experience a 20 percent cut if Ferguson signs the current proposed budget. However, Sisk said that program tends to be regionally under spent, so the cuts likely won’t have a large impact.
The two R.E.A.L. teams in Clallam County, run by PBH and Reflections Counseling, are outreach services that focus on people who are unhoused with untreated substance use problems. The goal, Sisk said, is to link those individuals to community resources, treatment and housing services, medical care and more, so those individuals can move toward their version of a successful life.
Once example of an outreach event the R.E.A.L. teams engage in is a weekly laundry day, during which the team helps provide laundry services to homeless individuals while talking with them about ways to provide support.
In addition to those funding cuts, Sisk said she is watching PBH’s federal grant dollars, given the recent instability in those funding sources.
“The days of plenty are gone,” she said. “I think that, in healthcare, we saw some really strategic investments during the public health emergency. We certainly have not anticipated those investments continuing forward.”
PBH, the largest behavioral healthcare organization in Clallam County, has more than 140 employees. Between all its programs, Sisk said it likely sees about 1 in 20 eastern Clallam County residents every year.
“We’ll continue to share with the community if things start to shift,” Sisk said. “Our goal, at the end of the day, is to try to reduce or eliminate any sort of risk of service disruption.”
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Reporter Emma Maple can be reached by email at emma.maple@peninsuladailynews.com.
